A recent Journal of Hospital Medicine study found that most hospitalists do not believe they should be involved in breast cancer screening for their hospitalized patients who are overdue for a screening.
Study authors at Johns Hopkins Bayview (JHB) Medical Center in Baltimore surveyed nearly 100 hospitalists about their thoughts on ordering a mammography for hospitalized women and possible concerns for hospitalists ordering inpatient screenings. Only 38% of those surveyed believed that hospitalists should be involved with breast cancer screening. The main concerns, according to survey takers, were following up on the results of the screening and that the mammography might not be covered by patients’ insurance.
The Hospitalist caught up with lead author Waseem Khaliq MD, MPH, who is a hospitalist and assistant professor of medicine at Johns Hopkins School of Medicine and a member of the JHB Cancer Committee.
Question: What are the key takeaways from this study?
Answer: About three years ago, we looked up what the adherence rate is among women who are admitted to the hospital for breast cancer screenings, and what we found was that a lot of these women were nonadherent to the breast cancer screening. So we polled those women who were nonadherent to the breast cancer screening and asked, “What if we were able to offer you a mammogram while you were in the hospital for other issues?” About 76% said that they would like to have a mammogram while they were in the hospital.
Looking at that background, we polled this question to our hospitalists, too. What we found out was that a lot of the hospitalists were not willing to order a mammogram or were not too excited about getting a breast cancer screening done in the hospital setting. A majority told us that they’re more worried about how those results are going to be followed up, and it is possible that even if they order this mammogram that it may interfere with patient care or patient discharge. Then who would cover the cost of the mammogram if they do it in the inpatient setting?
So although a third of the hospitalists would still order a mammogram for those women who were high risk … a majority of them were not willing to because there were some perceived barriers to that.
Q: What is your reaction to the concerns with screening inpatients?
A: I can understand the concerns that most of the hospitalists have in regard to screening every patient that comes to the hospital. What I think we can do is, at the very least, we can be smart enough to figure out if a patient were at high risk for developing cancer and at least have those patients who were at high risk get screened.
Q: Where do you think hospitalists should go from here with regard to their patients who are overdue for breast cancer screenings?
A: We need to test for the feasibility and the financial issue of actually getting a screening mammogram in the hospital setting. I think down the road it should not matter what setting a patient [intersects] with the health system; it could be inpatient or outpatient. Patients should be provided the care and prevention needs that are recommended for their routine care. The next step should be doing a feasibility study, looking at whether or not these mammograms can be done in the hospital setting and do not interfere with the patient’s acute care. TH
Candace Mitchell is a freelance writer in New Jersey.